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The mechanism appears to be interference with erythropoiesis
The physician should provide information to the patient about the signs and symptoms of hepatotoxiciy that should cause alarm (e.g., nausea, fatigue, lethargy, pruritus, jaundice, right upper quadrant tenderness and "flu-like" symptoms)
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For more details, see our article Homocysteine and Mild B12 Deficiency in Vegans
Quant EC, Jeste SS, Muni RH, et al
